Towing Application | Risk Management

Applicant Information
Legal Name of Company*
Effective Date of Coverage*
Mailing Address*
City*
State*
Zip Code*
Email Address*
Years in Business
Inspection Contact
Inspection Phone
Federal ID#
Type of Business
- Individual
- Corporation
- LLC
- Partnership
- Joint Venture
- Other (describe)

Towing
# of Employees
Payroll
Receipts
Service Station
# of Employees
Payroll
Receipts
Auto Mechanic
# of Employees
Payroll
Receipts
Auto Body Shop
# of Employees
Payroll
Receipts
Used Car Sales
# of Employees
Payroll
Receipts
Repossession
# of Employees
Payroll
Receipts
Trucking
If Trucking Section Completed, Need Receipts
# of Employees
Payroll
Receipts
Other
# of Employees - other
Payroll - other
Receipts - other

Description of Other Operations
Five Largest Clients For Which The Applicant Tows

(including police, commercial and auto clubs)
Client 1
% of Business
Client 2
% of Business
Client 3
% of Business
Client 4
% of Business
Client 5
% of Business

Is the Applicant involved in any repossession?
- Yes
- No
If yes, are the repossessions:
- voluntary?
- involuntary?
How many repossessions are performed each month?
Is the Applicant involved in anything other than towing?
- Yes
- No
(If yes, please complete the Operation Section)
Is applicant subsidiary of another entity or does applicant have any subsidiaries?
- Yes
- No
If yes, name and describe:
Is there a formal safety program in operation?
- Yes
- No
If yes, number of meetings held monthly
Who conducts?
(Include a copy of written safety program if one exists)
Is there a written vehicle maintenance program in operation?
- Yes
- No
Any vehicles leased, loaned or rented to others?
- Yes
- No
If yes, describe:
Are these vehicles included in the attached schedule?
- Yes
- No
If no, explain why:
Describe customized or special equipment OTHER THAN tow equipment
Any ICC filings required?
- Yes
- No
Any PUC filings?
- Yes
- No
If yes, list below:
Name Address
If yes, does Applicant comply with all record keeping required by D.O.T.?
- Yes
- No
Is MCS 90 Required?
- Yes
- No
Authority is granted in the name of:
Dealer Plates
ID#'s
Are Dealer Plates permanently attached to any vehicle?
- Yes
- No
If yes, give description of vehicle:
What are the dealer plates used for?
Any personal use of the plates?
- Yes
- No
How many times monthly does the Applicant go beyond 50 miles?
How many times monthly does the Applicant go beyond 200 miles?
What cities?
Does the Applicant carry Workers Compensation?
- Yes
- No
Policy Period
Insurance co.
What is the total number of vehicles the Applicant owns?
Does the Applicant pick up or deliver customer’s cars other than Towing?
- Yes
- No
If yes, what radius of operation?
Any Tire Sales?
- Yes
- No
If yes, receipts
How does the Applicant dispose of used tires?
Does the Applicant sell:
- New Tires
- Used Tires
Any tire recapping or retreading performed?
- Yes
- No
Does the Applicant own or sponsor a car for racing?
- Yes
- No
Any spray painting performed?
- Yes
- No
If yes, does Applicant have an UL approval spray booth?
- Yes
- No
Any welding performed?
- Yes
- No
If yes, where is welding performed?
Any protective screens used?
- Yes
- No
Untitled
- First Choice
- Second Choice
- Third Choice
Does the Applicant operate a service station?
- Yes
- No
Type of service station is:
- Self-Station
- Full-Service
- Both
Does the Applicant operate:
- C-Store
- Car Wash
Gallons sold annually
How many pumps does the Applicant have?
Does the Applicant have a pollution liability policy on the underground storage tanks?
- Yes
- No
Does the Applicant do any dismantling or salvage?
- Yes
- No
If yes, how many number of units annually?
Does the Applicant own a crushing machine?
- Yes
- No
If yes, describe here:
Is public allowed to removed parts from vehicles?
- Yes
- No
Is public allowed access to the salvage area?
- Yes
- No
Do employees regularly use their own vehicles on company business?
- Yes
- No
If yes, explain
Does the Applicant have any public parking for which charge is made?
- Yes
- No
If yes, number of units per month
Monthly Receipts $
Does Applicant have dogs on Premises?
- Yes
- No
If yes, number
If yes, breed
Are they Police/security trained Guard Dogs?
- Yes
- No
Are “Beware of Dog” signs posted on gate?
- Yes
- No
Are dogs penned up during business hours?
- Yes
- No
Location 1
Fenced (Y/N) Height Gates Locked at Night (Y/N) Watchman (Y/N) Alarm (Y/N) Avg. # of Cars
Location 2
Fenced (Y/N) Height Gates Locked at Night (Y/N) Watchman (Y/N) Alarm (Y/N) Avg. # of Cars
Location 3
Fenced (Y/N) Height Gates Locked at Night (Y/N) Watchman (Y/N) Alarm (Y/N) Avg. # of Cars
Location 4
Fenced (Y/N) Height Gates Locked at Night (Y/N) Watchman (Y/N) Alarm (Y/N) Avg. # of Cars
Location 5
Fenced (Y/N) Height Gates Locked at Night (Y/N) Watchman (Y/N) Alarm (Y/N) Avg. # of Cars
Days of operation
- Mon
- Tues
- Wed
- Thurs
- Fri
- Sat
- Sun
Normal hours of operation
- 0-12 hours
- 13-17 hours
- 18-24 hours
If storing cars, for whom and under what circumstances are autos stored by the Applicant?
Any change in operation, number of vehicles in the last 3 years?
- Yes
- No
If yes, please explain
Insurance Co. 1
Year Premium Limits Deductible # of Losses Amount
Insurance Co. 2
Year Premium Limits Deductible # of Losses Amount
Insurance Co. 3
Year Premium Limits Deductible # of Losses Amount
Insurance Co. 4
Year Premium Limits Deductible # of Losses Amount
Attach copy of insurance company loss runs
Has Applicant ever been cancelled or non-renewed?
- Yes
- No
(Do not answer if risk is located in MO)
If yes, why?

If so, please complete the SECTION below.
Items(s) Hauled Value Radius Vehicle Used How Often
Items(s) Hauled Value Radius Vehicle Used How Often
Items(s) Hauled Value Radius Vehicle Used How Often
Items(s) Hauled Value Radius Vehicle Used How Often
Which Drivers handle these operations?
Does the Applicant use air bags in its towing and recovery operations?
- Yes
- No
If yes, how many bags?
If coverage for equipment is desired, please attach list of equipment with I.D.#s and values.
Does the Applicant always use safety chains?
- Yes
- No
Does the Applicant, at any time, perform snow plowing?
- Yes
- No
If yes, who does the Applicant plow for?

Vehicle Schedule
Insured Name:
Date:
Vehicle #1
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location
Vehicle #2
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location
Vehicle #3
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location
Vehicle #4
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location
Vehicle #5
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location
Vehicle #6
Year Make Model Body Type Full Serial Stated Amount
GVW Class Code On-Hook Limiy Deductibles: Comp Deductibles: Collision Deductibles: On-Hook
Use of vehicle Radius of operation
Describe tow/specialty equipment separately (rotator, etc.) Garaging Location

Driver List
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Driver's Name DOB Driver's License # Date of Employment Status (Part-time / Full-time) Commercial Driving Experience Tow Truck Experience
Have you identified every possible driver of an insured vehicle including those who may fill in during peak periods and emergencies? (Such as members of households, friends, etc.)?
- Yes
- No
Name of Applicant
, understands and agrees that on any proposed addition or substitution of driver, the MVR must be submitted to the insurance company for approval prior to hire.

Step 1 of 8

Applicant Information

Towing

Service Station

Auto Mechanic

Auto Body Shop

Used Car Sales

Repossession

Trucking

Other

Five Largest Clients For Which The Applicant Tows

Driver Information:

If so, please complete the SECTION below.

Vehicle Schedule

Vehicle #1

Vehicle #2

Vehicle #3

Vehicle #4

Vehicle #5

Vehicle #6

Driver List

©2020 by Reliable Risk Management, LLC.